Abstract

With populations ageing and active treatment of urinary stones increasingly in demand, more patients with stones are presenting with an underlying bleeding disorder or need for regular thromboprophylaxis, by means of antiplatelet and other medication. A practical guide to thromboprophylaxis in the treatment of urinary tract lithiasis has not yet been established. Patients can be stratified according to levels of risk of arterial and venous thromboembolism, which influence the requirements for antiplatelet and anticoagulant medications, respectively. Patients should also be stratified according to their risk of bleeding. Consideration of the combined risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. The choice of shockwave lithotripsy, percutaneous nephrolithotomy or ureteroscopy with laser lithotripsy for treatment of lithiasis should be determined with regard to these risks. Although ureteroscopy is the preferred method in high-risk patients, shockwave lithotripsy and percutaneous nephrolithotomy can be chosen when indicated, if appropriate guidelines are strictly followed.

Comments
1

This is a useful article with information on how to clinically manage patients with bleeding disorders and anticoagulation treatment in association with modern stone surgery. There is a chapter with advice how to deal with warfarin and anti-platelet medication when SWL is planned. The basic rules in this regard was that warfarin should be stopped 5 days before the treatment and bridging therapy with low-molecular heparin given to most patients before the warfarin medication can be re-started after 48-78 h. It is furthermore recommended to stop anti-platelet treatment 7 days before SWL. The bottom-line is, however, that in patients at particularly high risk endoscopic treatment should be chosen instead of SWL. All these measures are highly important in order to reduce the risk of subcapsular hematoma.

This is a useful article with information on how to clinically manage patients with bleeding disorders and anticoagulation treatment in association with modern stone surgery. There is a chapter with advice how to deal with warfarin and anti-platelet medication when SWL is planned. The basic rules in this regard was that warfarin should be stopped 5 days before the treatment and bridging therapy with low-molecular heparin given to most patients before the warfarin medication can be re-started after 48-78 h. It is furthermore recommended to stop anti-platelet treatment 7 days before SWL. The bottom-line is, however, that in patients at particularly high risk endoscopic treatment should be chosen instead of SWL. All these measures are highly important in order to reduce the risk of subcapsular hematoma.
Hans-Göran Tiselius